Provider Demographics
NPI:1497112775
Name:HIBPSHMAN, SARA (BCBA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HIBPSHMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DIANN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 E OLD TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5845
Mailing Address - Country:US
Mailing Address - Phone:800-991-6070
Mailing Address - Fax:800-991-6071
Practice Address - Street 1:139 E OLD TRENTON RD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5845
Practice Address - Country:US
Practice Address - Phone:800-991-6070
Practice Address - Fax:800-991-6071
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-17-28433103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-28433OtherBEHAVIOR ANALYST CERTIFICATION BOARD